Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
Surgical Population Analysis Research Core, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
Urology. 2022 Aug;166:289-296. doi: 10.1016/j.urology.2022.04.020. Epub 2022 May 4.
To compare trends in the treatment of patients with myelomeningocele receiving intravesical Botulinum (IVB) toxin and enterocystoplasty.
We identified patients with myelomeningocele in a commercial insurance database from 2008-2017 and stratified them into adult and pediatric samples. Index procedure was identified as either IVB toxin injection or enterocystoplasty. The annual rate of treatments was measured and a change in treatment rate was identified. Time to enterocysplasty was calculated using survival analysis and factors associated with clinical outcomes up to 10 years after index procedure were determined using multivariate Poisson regression.
We identified 60,983 patients with myelomeningocele. Nearly twice as many pediatric patients had an enterocystoplasty (n = 317) compared to IVB (n = 138). Very few adult patients underwent enterocystoplasty (n = 25) compared to IVB (n = 116). We identified a significant increase in the annual rate of IVB use around mid-2010 among pediatric patients and around mid-2009 among adults. Twelve pediatric patients (8.6%) and 5 adults (4.3%) went on to receive an enterocystoplasty. Patients who received IVB as the index procedure experienced significantly lower rates of hospitalization days (RR 0.64; 95% CI 0.53-0.78), emergency department visits (RR 0.72; 95% CI 0.63-0.82), and an increased rate of urologic procedures (RR 1.44; 95% CI 1.28-1.62).
The annual rate of IVB use has increased among patients with myelomeningocele. Nearly 1 in 10 pediatric patients and 1 in 20 adults go on to receive enterocystoplasty. Patients who receive IVB experience lower rates of hospitalization and emergency department visits compared to patients who receive enterocystoplasty.
比较接受膀胱内肉毒杆菌毒素（IVB）和肠囊膀胱成形术治疗的脊髓脊膜膨出患者的治疗趋势。
我们从 2008 年至 2017 年在商业保险数据库中确定了脊髓脊膜膨出患者，并将他们分为成人和儿科样本。索引程序被确定为 IVB 毒素注射或肠囊膀胱成形术。测量治疗的年率，并确定治疗率的变化。使用生存分析计算肠囊膀胱成形术的时间，并使用多变量泊松回归确定索引程序后 10 年内与临床结果相关的因素。
我们确定了 60983 名脊髓脊膜膨出患者。与 IVB 相比，接受肠囊膀胱成形术的儿科患者几乎多一倍（n=317），而接受 IVB 的儿科患者则少得多（n=138）。与 IVB 相比，接受肠囊膀胱成形术的成年患者（n=25）非常少。我们发现，儿科患者的 IVB 使用率在 2010 年年中左右，以及成年患者在 2009 年年中左右有显著增加。12 名儿科患者（8.6%）和 5 名成年患者（4.3%）接受了肠囊膀胱成形术。作为索引程序接受 IVB 的患者住院天数（RR 0.64；95%CI 0.53-0.78）、急诊就诊（RR 0.72；95%CI 0.63-0.82）和泌尿科手术（RR 1.44；95%CI 1.28-1.62）的发生率显著降低。
脊髓脊膜膨出患者中 IVB 的使用年率有所增加。近 10 名儿科患者中有 1 名和 20 名成年患者中有 1 名接受肠囊膀胱成形术。与接受肠囊膀胱成形术的患者相比，接受 IVB 的患者的住院和急诊就诊率较低。
